Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2022; 10(6): 1929-1936
Published online Feb 26, 2022. doi: 10.12998/wjcc.v10.i6.1929
Concurrent ankylosing spondylitis and myelodysplastic syndrome: A case report
Guan-Hua Xu, Jin Lin, Wei-Qian Chen
Guan-Hua Xu, Jin Lin, Wei-Qian Chen, Division of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Author contributions: Xu GH prepared and wrote the manuscript; Xu GH, Lin J, and Chen WQ performed the literature research and data analysis; Chen WQ edited and approved the manuscript.
Supported by National Natural Science Foundation of China, No. 81701600.
Informed consent statement: Informed written consent was obtained from the patient’s mother for publication of this case report.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Qian Chen, Doctor, MD, PhD, Chief Doctor, Chief Physician, Division of Rheumatology, the First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. cwq678@zju.edu.cn
Received: August 3, 2021
Peer-review started: August 3, 2021
First decision: October 20, 2021
Revised: November 1, 2021
Accepted: January 14, 2022
Article in press: January 14, 2022
Published online: February 26, 2022
Processing time: 204 Days and 7.9 Hours
Abstract
BACKGROUND

Ankylosing spondylitis (AS) is an autoimmune disease characterized by sacroiliitis and spondylitis, with a few hematological abnormalities. Myelodysplastic syndromes (MDS) are a heterogeneous group of hematopoietic stem cell disorders with frequent autoimmune phenomena. The relationship between AS and MDS remains unknown.

CASE SUMMARY

We describe a rare case of concurrent AS and MDS. An 18-year-old man with low back pain and anemia was diagnosed with AS; however, the cause of anemia could not be determined by the first bone marrow examination. He recovered from anemia and the symptoms of AS resolved after treatment with etanercept, glucocorticoid, and blood transfusion, but he developed pancytopenia with an increased myeloblast count (from 2.5% to 9%). Chromosome analysis revealed del(7q) and trisomy 8. Refractory anemia with excess of blasts-1 (RAEB-1)/MDS was confirmed by repeating the bone marrow examination. He became blood transfusion-dependent and received decitabine-based chemotherapy but eventually died.

CONCLUSION

We suspect that AS may be an early autoimmune phenomenon related to MDS. However, a condition of coexistence cannot be excluded.

Keywords: Ankylosing spondylitis; Etanercept; Myelodysplastic syndromes; Sacroiliitis; Case report

Core Tip: We report a case of simultaneous presentation of ankylosing spondylitis (AS) and myelodysplastic syndrome (MDS). Patients with MDS may have autoimmune manifestations. AS may be an early autoimmune phenomenon associated with MDS; however, the possibility of a coincidence cannot be excluded. Most importantly, AS may cause anemia, but it is usually mild. If a patient with AS presents with severe anemia, it must be diagnosed as a hematopoietic system pathology. Chemotherapy or bone marrow transplantation should be considered for acute leukemia.